高中生手機使用與護眼行為教育介入成效評估

Abstract

本研究旨在發展以生活技能為導向的課程，設計學生手機使用時間管理與護眼行為課程並且評估手機使用時間管理與護眼行為課程教育介入的成效。課程設計著重於三項生活技能，分別為「做決定技能」、「自我健康管理/監督技能」以及「壓力管理技能」，目的為增加學生手機使用之風險感知、手機使用時間管理與護眼行為之自我效能、手機使用時間管理與護眼行為之行為意圖。 本研究乃依據需求評估設計四堂50分鐘之課程，並且採準兩組前後測之準實驗研究設計進行成效評估。本研究選取台中某高中一年級以及三年級學生進行教育介入，介入期間為109年9月至11月，參與之學生總人數為469人。本研究採立意取樣將班級分派為兩組，其中，實驗組學生（n=236)接受本研究所設計之課程介入，對照組學生(n=233)則持續接受正規課程中之健康與護理教育課程。本研究採用描述性統計以次數分配與百分比描述類別資料，以平均數、標準差描述等距資料，推論性統計以卡方檢定、獨立樣本t檢定檢視實驗組與對照組基本資料是否有差異，最後採廣義估計方程式（Generalized Estimating Equations）分析教育介入之成效。此外，本研究亦分析學生於學習單中之回饋內容，以輔助量化研究之結果闡述。 本研究的結果顯示，研究量表具高度之內部一致性， Cronbach’s α達 0.7以上。依據廣義估計方程式（Generalized Estimating Equations）分析教育介入之成效，在控制背景變項之後運用教育介入則學生手機使用之風險感知增加（β=0.16，P<0.001）、手機使用時間管理與護眼行為之自我效能增加（β=0.43，P<0.001）、手機使用時間管理與護眼行為之行為意圖增加（β=0.47，P<0.001）。整體而言，以生活技能為導向之課程能有效提升手機使用時間管理與護眼行為之自我效能，以及手機使用時間管理與護眼行為之行為意圖。惟，本研究結果並未顯著性的改善學生手機使用時間(β=-0.41，P=0.479)、手機使用之護眼保健行為 (β=0.06， P=0.309)、手機成癮的情形(β=-0.05， P=0.201)。此外，根據質性資料分析顯示透過課程的設計學生已開始警覺自身手機使用的時間、使用手機可能帶來的負面影響，甚至開始運用生活技能的策略來管理手機使用行為。 本研究建議，以生活技能為基礎的教育介入可以有效的提升有關眼睛健康和手機使用的風險意識；提高自我效能；提升手機使用時間管理和護眼行為的行為意圖；而且可以併入現有高中的健康教育課程。未來研究，需要進行進一步的探討與研究個別化的介入及手機使用時間管理和護眼行為長期的影響。 最後，未來的教育介入可以納入家長與教師合作的策略。

The purpose of this study was to develop a life skills-based health education curriculum and evaluate its effectiveness as a health educational intervention. The curriculum design focused on three life skills – decision making; self-management and mentoring; and stress management skills, with the objective to increase students’ risk perceptions regarding smartphone use; self-efficacy of smartphone use time management and eye health promotion behaviors; behavior intentions toward smartphone use time management and eye health promotion behaviors. We designed four 50-minute education sessions based on a needs assessment, and evaluated the effects of an educational intervention using a two-group pre- and post- quasi-experimental design. The intervention was implemented with 469 students in grades 10th and 12th at a high school in Taichung during the time period September to November, 2020. We assigned students into two groups. The experimental group (n=236) received four 50-minute sessions focusing on smartphone use time management and eye health promotion behaviors while the control group (n=233) received their regular health and nursing education courses. Descriptive statistics, independent sample t test and chi-square test was used to perform the statistical analysis. The Generalized Estimating Equation (GEE) method was used to carry out the statistical analysis assessing effects of the educational intervention. In addition, this study also analyzed feedback from students to help explain the findings from the quantitative analysis. Our study showed that the internal validity of the research instruments is high (Cronbach’s α higher than 0.7). According to the results from the GEE, the educational intervention improved the students' risk perceptions toward smartphone use (β=0.16, P<0.001） and enhanced their self-efficacy (β=0.43, P<0.001) and behavioral intentions towards smartphone use time management (β=0.47, P<0.001); eye health promotion behaviors (β=0.06, P=0.309); smartphone use time(β=-0.41, P=0.479); and smartphone addiction (β=-0.05, P=0.201). However, our study did not show that there was a statistically significant impact on smartphone use time, eye health promotion behaviors, and smartphone addiction. In addition, qualitative analyses of student feedback showed that students are aware of their smartphone use time, negative impacts of smartphone, and tried to use life skills to manage their smartphone use time during the intervention period. This study suggests that a life skills-based educational intervention is an effective way to increase the risk awareness regarding smartphone use; enhance self-efficacy; introduce behavioral intentions towards smartphone usage, time management, and eye health promotion behaviors; and can be incorporated into the existing health and nursing education courses in high schools. Future research is needed to explore tailored versus individualized interventions, as well as a study to evaluate the long-term effects on smartphone use time management and eye health promotion behaviors among high school students. Finally, future educational intervention can incorporate parent-teacher partnerships strategy.